Rate of neurological diagnosis in patients with hemisensory syndrome – A retrospective cross-sectional study

Rate of neurological diagnosis in patients with hemisensory syndrome – A retrospective cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rate of neurological diagnosis in patients with hemisensory syndrome – A retrospective cross-sectional study Ilia Urman, Keren Sabah, Jonathan Naftali, Ruth Djaldetti This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8552834/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Mar, 2026 Read the published version in Acta Neurologica Belgica → Version 1 posted You are reading this latest preprint version Abstract Purpose Hemisensory syndrome (HS) is a subjective unilateral sensory abnormality that causes reduced sensation and chronic pain, with no additional objective findings, posing a diagnostic challenge. We aimed to determine the rate of neurological diagnosis among patients with hemisensory complaints and identify clinical tools to aid in the diagnosis. Methods A cross-sectional retrospective study was conducted using data collected from 194 patients who presented to the emergency department of a tertiary medical center with hemisensory complaints in 2010-2020. Their medical records were screened for demographic and clinical features and the results of all ancillary examinations. Results A neurological diagnosis was reached for 55/194 patients (28.3%), mainly acute stroke/transient ischemic attack in 24 (43.6%), migraine in 14 (25.4%), and multiple sclerosis in 13 (23.6%). The likelihood of diagnosis was not significantly affected by gender, side involvement, or use of chronic medications. Rate of pyramidal signs and mean triglyceride level were increased in the diagnosis group. Brain magnetic resonance imaging (MRI) was the largest clinical contributor to the diagnosis, demonstrating pathological findings in 59% of the diagnosis group (versus zero in the no-diagnosis group) and in 21% of all patients who underwent MRI. Conclusions The yield of extensive investigations in patients with HS is low, and in only one-fourth of cases is the etiology determined. Brain MRI appears to be the most efficient neuroimaging tool available. Addition variables need to be defined to aid clinicians in identifying patients warranting a comprehensive medical examination and in determining which tests to apply. Hemisensory syndrome Brain MRI Diagnostic yield Figures Figure 1 Introduction Hemisensory syndrome (HS) is characterized by a sensory disturbance on one side of the body, without other neurological signs on examination [ 1 ]. Many patients also complain of chronic pain involving the affected body part or additional symptoms such as blurry vision or hearing abnormalities on the ipsilateral side [ 2 , 3 ]. HS can be complete or incomplete. Incomplete HS may present clinically as cheiro-oral-crural syndrome, cheiro-oral syndrome, and isolated oral syndrome [ 4 ]. Case studies of HS have been reported for the last 150 years. Although symptoms were initially considered to be conversive or psychogenic [ 5 ], later studies identified several organic causes, such as stroke [ 6 ], seizures, demyelinating lesions, and inflammatory lesions involving the central nervous system [ 7 ]. However, extensive clinical investigations tended to yield unclear pathological results, leading to difficulties in diagnosis and treatment [ 7 ]. This has remained true even with the significant progress made in recent years in improving the quality of available tests for the investigation of neurological symptoms [ 8 ]. The aim of the present study was to evaluate the rate at which organic neurological diagnoses are reached in patients who present with HS. In addition, we sought to identify the most relevant clinical diagnostic tests in this setting and to determine the demographic and clinical features characteristic of patients with HS who receive a neurological diagnosis compared to those who do not. Materials and methods Study design A retrospective cross-sectional study was conducted at a tertiary medical center. Data were derived by search of the integrated electronic medical records system using Chameleon (Elad Solutions Ltd., Tel Aviv, Israel) and Ofek (Clalit Health Services, Israel) software. Standard protocol approvals, registrations, and patient consents Standard protocol approvals, registrations, and patient consents The study was conducted in adherence with the Declaration of Helsinki (2024 revision) and approved by the Ethics Committee of Rabin Medical Center (approval no 0322-20-RMC), which waived the need for informed consent. Study population The cohort included all adult patients (age ≥ 18 years) who presented to the emergency department (ED) of a tertiary medical center in 2010–2020 with a unilateral sensory complaint. Patients were identified by review of the on-line medical records for the following ICD-9-CM codes: V48.4, sensory problems with the head; V49.3, sensory problems with limbs; and V48.5, sensory problems with the neck and trunk. Exclusion criteria were lack of data on the investigations used to evaluate symptoms and patient failure to complete the required investigations within a year from symptom onset. Data collection Demographic and clinical data were collected from the electronic medical files of every patient who attended the ED, including vascular risk factors (hypertension, diabetes, smoking) and history of vascular diseases (ischemic heart disease, stroke/transient ischemic attack); history of migraine; autoimmune diseases (systemic lupus erythematosus, sarcoidosis, etc. at the time of presentation); active cancer (i.e., receiving chemotherapy at the time of presentation); and psychiatric diseases (documented psychiatric diagnosis and ongoing psychiatric follow-up at the time of presentation). Thereafter, we checked that all patients had undergone medical and radiologic investigations for their symptoms within a year of presentation. Those who had not, were excluded from the analysis. For computed tomography (CT) scans, abnormal diagnostic were defined as a single new infarct, multiple new infarcts, a space-occupying lesion, or a vascular lesion. All abnormal findings include all the above, with the addition of any abnormality identified on the scan such as brain atrophy, chronic ischemic changes. Additional abnormal diagnostic findings on Magnetic resonance imaging (MRI) were demyelinating lesions and encephalitis. The groups were compared for the total number of patients exhibiting any one of these diagnostic abnormalities identified on the CT scan or MRI. EEG was considered pathological if epileptic activity was evident on the scan, and Doppler ultrasonography (US) was considered abnormal if the scan showed carotid stenosis above 70% on the contralateral side of the sensory disturbance(s). Study endpoints The primary endpoint of the study was the percentage of patients presenting with HS who received a neurological diagnosis. The secondary endpoints were demographic and clinical features typical of the patients who received a neurological diagnosis compared to those who did not, and the specific tests that contributed most to reaching the diagnosis. Statistical analysis Descriptive statistics were used to summarize demographic, clinical, and diagnostic characteristics. Continuous variables were summarized as mean ± standard deviation or, if not normally distributed, as median and interquartile range. Categorical variables were suammarized as number and percentage of patients. Group comparisons were performed between patients with and without a final neurological diagnosis Continuous variables were compared between groups using t-test and Mann-Whitney test, as appropriate, and categorical values were compared using Pearson’s chi-square or Fisher exact test. A two-sided p -value < 0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY). Results Of the total 1116 patients who were examined for sensory symptoms between 2010 and 2020, 922 were excluded from the study mainly because of the presence of mild motor symptoms as well. The remaining 194 formed the study group. Following a comprehensive clinical examination and neurological work-up, 55 (28.3%) received a neurological diagnosis, namely, stroke or transient ischemic attack (24/55, 43.6%), migraine (14/55, 25.4%), multiple sclerosis (13/55, 23.6%), epilepsy (2/55, 3.6%), encephalitis (1/55, 1.8%) and space occupying lesion (1/55, 1.8%). Demographic and baseline characteristics (Table ) Table 1 Demographic and baseline characteristics by group Characteristic No diagnosis (n = 139) Diagnosis (n = 55) p Value Age (yr), median (IQR) 42 (33, 51) 41 (33, 54) 0.69 Sex (female) 82 (59%) 38 (69%) 0.19 Residence in periphery (n = 193) 6 (5%) 3 (6%) 0.72 Education level (n = 136) 0.66 Elementary 6 (6%) 1 (2%) High school 40 (38%) 17 (45%) Academic 53 (50%) 19 (50%) Family status 0.97 Unmarried 16 (12%) 6 (11%) Married 103 (74%) 43 (78%) Separated 10 (7%) 4 (7%) Widowed 3 (2%) 1 (2%) Children, median (IQR) 3 (2,3) 3 (1,4) 0.63 Smokers (n = 191) 39/139 (28%) 14/55 (25%) 0.4 Dominant hand Right handed (n = 80) 55/58 (93%) 19/22 (90%) 0.34 Different from overall body dominance 39/58 (67%) 12/22 (55%) 0.29 IQR, interquartile range Comparison of the demographic and baseline characteristics between patients with and without a diagnosis yielded no statistically significant differences age (median 41 years in the diagnosis group and 42 years in the no-diagnosis group, p = 0.69), gender ratio, education, or marital status. The majority of patients in both groups were married and had a median of three children. The diagnosis group had a higher proportion of females (69% vs. 59%), but the difference was not statistically significant ( p = 0.19). Residence in the geographic periphery was rare and similarly distributed between the groups (5% vs. 6%, p = 0.72). Most patients had a high school or academic level of education. The dominant hand was right in 92% of patients ( p = 0.34). Smoking status was similar in the two groups ( p = 0.4). Risk factors and medical background (Table 2 ) Table 2 Risk factors and comorbidities by group Risk factor No diagnosis (n = 139) Diagnosis (n = 55) p Value Vascular risk factors 37 (27%) 18 (33%) 0.39 Autoimmune disease 10 (7%) 5 (9%) 0.66 Active malignancy 5 (4%) 1 (2%) 1 Chronic inflammatory disease 5 (4%) 1 (2%) 1 Psychiatric diagnosis 10 (7%) 2 (4%) 0.51 History of migraines 4 (3%) 5 (9%) 0.009 Medication use Any medication 46/139 21/55 0.50 Antiplatelet agents (aspirin, clopidogrel, or prasugrel) 20 (14%) 12 (22%) 0.2 Anticoagulation therapy (warfarin, apixaban, rivaroxaban, dabigatran) 6 (4%) 2 (4%) 1 Beta blockers or calcium channel blockers 12 (9%) 4 (7%) 1 Statins 13 (9%) 9 (16%) 0.16 ACE inhibitors or angiotensin receptor blockers 12 (9%) 7 (13%) 0.38 Oral antidiabetic medications 7 (5%) 6 (11%) 0.14 Insulin 2 (1%) 3 (5%) 0.11 Corticosteroids 4 (3%) 0 (0%) 0.58 Antidepressants (SSRIs or SNRIs) 9 (6%) 2 (4%) 0.73 Cholesterol panel Total cholesterol (mg/dl), median (IQR) 175 (151,198) 181 (163,204) 0.133 LDL (mg/dl), median (IQR) 97 (75, 122) 101 (84, 126) 0.177 HDL (mg/dl), median (IQR) 53 (38, 63) 46 (39, 62) 0.213 Triglycerides (mg/dl), median (IQR) 107 (72, 157) 130 (91,188) 0.036 IQR, interquartile range; ACE, angiotensin-converting enzyme; SSRI, selective serotonin reuptake inhibitor; SSNR, serotonin and norepinephrine reuptake inhibitor; LDL, low density lipoprotein; HDL, high density lipoprotein On analysis of potential risk factors and comorbidities, there was no difference between the groups in the rate of vascular risk factors (33% vs. 27, p = 0.39) or rates of autoimmune diseases and chronic inflammatory conditions, which were low in both. History of migraine was more common in the diagnosis group (9% vs. 3%, p = 0.009). Use of any medications, including anticoagulants, statins, anti-hypertensive drugs, diabetes medication, and antidepressants did not differ significantly between the groups. Lipid panel results, including total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were broadly similar, although triglyceride levels were significantly higher in the diagnosis group (median 130 vs. 107 mg/dL, p = 0.036). Neurological examination and tests (Table 3 ) Table 3 Neurological examination and tests by group Clinical complaint/ abnormality found No. pts. evaluated (N = 194) Diagnosis group (n = 55) No-diagnosis group (n = 139) p value Associated diagnoses Presentation Impaired sensation 194 (100%) 30/55 (55%) 86/139 (62%) 0.35 Demyelination (n = 10), Stroke (n = 11), SOL (n = 1), Epilepsy (n = 1), Migraine (n = 7) Tendon reflex 194 (100%) 11/55 (20%) 11/139 (8%) 0.023 Demyelination (n = 3), Stroke (n = 4), SOL (n = 1), Epilepsy (n = 1), Migraine (n = 2) Plantar response 194 (100% 7/55 (13%) 6/139 (4%) 0.052 Demyelination (n = 2), Stroke (n = 5) Any complaint 194 (100%) 35/55 (64%) 94/139 (68%) 0.62 Demyelination (n = 11), Stroke (n = 13), SOL (n = 1), Encephalitis (n = 1), Epilepsy (n = 2), Migraine (n = 8) Imaging CT – any abnormal finding 179 (92%) 21/48 (44%) 10/131 (8%) < 0.01 Stroke (n = 6), Migraine (n = 1), Epilepsy (n = 1) CT – abnormal diagnostic findings a 179 (92%) 6/48 (13%) 0/131 (0%) < 0.01 Stroke (n = 6) MRI – any abnormal finding 130 (67%) 27/46 (59%) 6/84 (7%) < 0.01 Demyelination (n = 13), Stroke (n = 12), SOL (n = 1), Encephalitis (n = 1) MRI – abnormal diagnostic findings b 130 (67%) 27/46 (59%) 0/84 (0%) < 0.01 Demyelination (n = 13), Stroke (n = 12), SOL (n = 1), Encephalitis (n = 1) EEG 39 (20%) 2/10 (20%) 0/29 (0%) 0.061 Epilepsy (n = 2) Doppler US 77 (40%) 1/53 (2%) 1/24 (4%) 0.56 Stroke (n = 1) SEP 11 (6%) 4/8 (50%) 0/3 (0%) 0.24 Demyelination (n = 4) Echocardiogram 62 (32%) 4/21 (19%) 5/41 (12%) 0.47 Stroke (n = 4) Normal in all diagnostic tests (194/194, 100%) 194 (100%) 20/55 (36%) 120/139 (86%) < 0.01 Migraine (n = 14), TIA (n = 6) a At least one of the following: single new infarct, multiple new infarcts, space-occupying lesion, or vascular lesion b At least one of the following: single new infarct, multiple new infarcts, space-occupying lesion, vascular lesion, demyelination or encephalitis CT, computed tomography; EEG, electroencephlogram; MRI, magnetic resonance imaging; SOL, space-occupying lesion; TIA, transient ischemic attack; US, ultrasound; SEP, somatosensory evoked potential Objective neurological abnormalities were detected in 35/55 of patients in the diagnosis group (64%) and 94/139 (68%) in the no-diagnosis group. Compared to the no-diagnosis group, the diagnosis group had a significantly higher rate of abnormalities of deep tendon reflex (11/55, 55% vs 11/139, 8%, p = 0.023) and plantar response (7/55, 13% vs. 6/139, 4%, p = 0.052). Neuroradiological examinations were performed in all patients, including head CT in 179 (92.3%), brain MRI in 130 (67.0%), carotid Doppler ultrasound in 77 (39.7%), echocardiography in 62 (32.0%), EEG in 39 (20.1%), and somatosensory evoked potentials in 11 (5.7%). Given the relatively low number of patients undergoing most tests, diagnostic yield was further analyzed only for CT and MRI. Among the 179/194 patients who underwent CT scanning, 31 (17.3%) had any abnormal findings. These included abnormal diagnostic findings in 6/48 patients (13%) in the diagnosis group and none of the 131 patients in the no-diagnosis group ( p < 0.01). MRI had the highest diagnostic yield. Of the 130/194 patients who underwent MRI, 33 (25.3%) had any abnormal findings. These included abnormal diagnostic findings in 27/46 patients (58.7%) in the diagnosis group and none of the 84 patients in the no-diagnosis group ( p < 0.01). EEG showed epileptogenic findings in 2/10 patients (20%) in the diagnosis group and none of the 29 patients in no-diagnosis group ( p = 0.061). (see Table 3 , Fig. 1 ) Discussion The present study showed that despite a comprehensive clinical investigation, of all patients who presented to the ED of a tertiary medical center with a unilateral sensory complaint, only one-fourth ultimately received a neurological diagnosis. The diagnosis group contained a higher proportion of females than the no-diagnosis group, but the results were clinically nonsignificant. The diagnosis group was characterized by a significantly higher mean triglyceride level and higher rate of history of migraine, with no significant between-group difference in chronic use of medication, side involved, or laboratory values other than triglycerides. Among the neuroimaging tests used, MRI contributed the most to identifying the etiology of the syndrome. Very few case series have addressed the yield of the diagnostic work-up performed in patients with symptoms of HS. In a previous study of 34 patients, only one was diagnosed on the basis of neuroimaging; findings in the remainder were considered benign [ 8 ]. Another study identified pure sensory stroke in 4.7% of all acute stroke cases [ 4 ]. Indeed, it has been reported that subjective sensory hypersensitivity frequently follows acute stroke, especially when the insula, claustrum, and rolandic operculum are involved [ 9 ]. These observations suggest that focusing investigations on these areas might improve our understanding of the underlying mechanism of sensory disturbances. HS may also be associated with complex regional pain syndrome, in which the sensory disturbances intensify with pain chronicity [ 10 ]. In these cases, 33% of patients have a sensory impairment beyond the affected limb [ 11 ]. In our study, a neurological diagnosis was achieved in a minority of patients and was more likely in females. The higher proportion of female patients in the diagnosis group was surprising given past research and publications that attributed hemisensory disturbances to non-organic causes [ 12 ], which are mainly attributed to young women with psychiatric disorders [ 13 ]. The higher proportion could be explained by the higher incidence of migraine and demyelinating diseases in females [ref here?]. The results also showed that in patients in whom a neurological diagnosis was not reached, the non-dominant side was more involved than the dominant side, which supported our initial hypothesis, although the difference was not statistically significant. It is noteworthy that the study sample was small and data for hand dominance were available for less than half the patients (81/194), which may have affected the reliability of the results. The literature on lateralization of symptoms is also inconclusive. In one systematic review of 121 eligible studies comprising 1139 patients, when laterality was mentioned in the title of the study, a higher percentage of the cohort was reported to have greater left side than right side involvement (66%). However, when lateralization was not mentioned in the title, no meaningful difference in side involvement (53% vs 57%) was seen [ 14 ]. Pyramidal signs (tendon reflex and plantar response) and signs of corticospinal tract lesions were more abundant in the diagnosis than the no-diagnosis group. Of all the examinations performed, brain MRI contributed the most to the diagnosis, revealing pathological findings in 59% of patients with a neurological diagnosis, and 21% of all patients who underwent MRI. Data on chronic medication use were sparse, and patients under chronic medication accounted for only a small proportion of the total cohort. Additional studies are needed to address these issues. Smokers did not demonstrate a higher rate of neurological diagnosis than non-smokers. This finding was surprising given the known harms of smoking. It is possible that because unilateral sensory disturbances affect a relatively young population (median age of our cohort was 42 years), the cumulative damage from smoking had not yet manifested, as in the case of ischemic stroke. While the group with a neurologic diagnosis had a higher mean triglyceride level than the group with no diagnosis, there were no between-group differences in levels of HDL, LDL, and total cholesterol. These findings may reflect the increased vascular morbidity in patients with dyslipidemia, although further study is required to determine why the greatest difference was found specifically for triglycerides. This study has several limitations. The retrospective design, as noted, has inherent biases which may have affected the results, and the single-center setting might adversely affect the generalizability of the findings to populations with different characteristics. Moreover, our exclusion of patients who did not complete the recommended clinical evaluation within a year of onset of their complaints could have introduced a selection bias, as we might have missed patients in whom the sensory disturbance had resolved and therefore did not require further treatment. Finally, the small size of the study sample lowered the statistical power of the analysis. In conclusion, the present study suggests that the rate of achieving a neurological diagnosis in patients who present with HS is low. In most cases, the etiology of the sensory disturbance will not be found despite extensive investigation. The test that made the greatest contribution to the diagnosis was brain MRI. The results of this study emphasize the need to define additional variables that would aid treating physician in identifying patients in whom a comprehensive medical examination is warranted and which tests to apply, sparing others unnecessary and sometimes costly interventions. Additional studies including broader populations are needed to validate our results and provide additional clinically meaningful data. Declarations Author Contribution I.U- Writing of manuscript text, Data collectionK.S - Data collection.J.F - statistical analysis.R.D - Critical review of manuscript, methodology. Funding No funding was received for this study. Data availability The data that support the findings of this study are available from the corresponding author (Ilia Urman), upon request. Ethics approval This study was conducted in adherence with the Declaration of Helsinki (2024 revision) and approved by the Ethics Committee of Rabin Medical Center (approval no 0322-20-RMC), which waived the need for informed consent. C ompeting interest The authors declare no competing interests. Conflict of interest All authors have declared that they do not have any conflicts of interest. References Koh PX, Ti J, Saffari SE, Lim ZYIC, Tu T (2021) Hemisensory syndrome: Hyperacute symptom onset and age differentiates ischemic stroke from other aetiologies. BMC Neurol 21:179. https://doi.org/10.1186/s12883-021-02206-8 Stone J, Carson A, Sharpe M (2005) Functional symptoms and signs in neurology: assessment and diagnosis. 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J Neurol Neurosurg Psychiatry 73:578-581. https://doi.org/10.1136/jnnp.73.5.578 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Mar, 2026 Read the published version in Acta Neurologica Belgica → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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12:00:38","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85856,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8552834/v1/3abf4a991335f974ff503a81.html"},{"id":100401508,"identity":"08a2035b-81ac-4cb1-8760-837dc1f4b2c5","added_by":"auto","created_at":"2026-01-16 11:58:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42862,"visible":true,"origin":"","legend":"\u003cp\u003eThe histogram presents the distribution of diagnostic test results among patients with and without a final neurological diagnosis. Each bar represents the total number of tests performed, with color segments indicating abnormal and normal findings in both groups, and percentages referring to the proportion of abnormal results relative to the total tested.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8552834/v1/c34feb78cb279a1c95a373c4.jpg"},{"id":105754974,"identity":"f8b59893-e68a-4797-b516-9c7b35ed3c3f","added_by":"auto","created_at":"2026-03-30 16:23:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1256898,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8552834/v1/66ca7206-57ee-43ce-83b5-71bc9215fab3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rate of neurological diagnosis in patients with hemisensory syndrome – A retrospective cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHemisensory syndrome (HS) is characterized by a sensory disturbance on one side of the body, without other neurological signs on examination [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Many patients also complain of chronic pain involving the affected body part or additional symptoms such as blurry vision or hearing abnormalities on the ipsilateral side [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. HS can be complete or incomplete. Incomplete HS may present clinically as cheiro-oral-crural syndrome, cheiro-oral syndrome, and isolated oral syndrome [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCase studies of HS have been reported for the last 150 years. Although symptoms were initially considered to be conversive or psychogenic [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], later studies identified several organic causes, such as stroke [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], seizures, demyelinating lesions, and inflammatory lesions involving the central nervous system [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, extensive clinical investigations tended to yield unclear pathological results, leading to difficulties in diagnosis and treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This has remained true even with the significant progress made in recent years in improving the quality of available tests for the investigation of neurological symptoms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of the present study was to evaluate the rate at which organic neurological diagnoses are reached in patients who present with HS. In addition, we sought to identify the most relevant clinical diagnostic tests in this setting and to determine the demographic and clinical features characteristic of patients with HS who receive a neurological diagnosis compared to those who do not.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA retrospective cross-sectional study was conducted at a tertiary medical center. Data were derived by search of the integrated electronic medical records system using Chameleon (Elad Solutions Ltd., Tel Aviv, Israel) and Ofek (Clalit Health Services, Israel) software.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStandard protocol approvals, registrations, and patient consents\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eStandard protocol approvals, registrations, and patient consents\u003c/div\u003e \u003cp\u003e The study was conducted in adherence with the Declaration of Helsinki (2024 revision) and approved by the Ethics Committee of Rabin Medical Center (approval no 0322-20-RMC), which waived the need for informed consent.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe cohort included all adult patients (age\u0026thinsp;\u0026ge;\u0026thinsp;18 years) who presented to the emergency department (ED) of a tertiary medical center in 2010\u0026ndash;2020 with a unilateral sensory complaint. Patients were identified by review of the on-line medical records for the following ICD-9-CM codes: V48.4, sensory problems with the head; V49.3, sensory problems with limbs; and V48.5, sensory problems with the neck and trunk. Exclusion criteria were lack of data on the investigations used to evaluate symptoms and patient failure to complete the required investigations within a year from symptom onset.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eDemographic and clinical data were collected from the electronic medical files of every patient who attended the ED, including vascular risk factors (hypertension, diabetes, smoking) and history of vascular diseases (ischemic heart disease, stroke/transient ischemic attack); history of migraine; autoimmune diseases (systemic lupus erythematosus, sarcoidosis, etc. at the time of presentation); active cancer (i.e., receiving chemotherapy at the time of presentation); and psychiatric diseases (documented psychiatric diagnosis and ongoing psychiatric follow-up at the time of presentation).\u003c/p\u003e \u003cp\u003eThereafter, we checked that all patients had undergone medical and radiologic investigations for their symptoms within a year of presentation. Those who had not, were excluded from the analysis.\u003c/p\u003e \u003cp\u003eFor computed tomography (CT) scans, abnormal diagnostic were defined as a single new infarct, multiple new infarcts, a space-occupying lesion, or a vascular lesion. All abnormal findings include all the above, with the addition of any abnormality identified on the scan such as brain atrophy, chronic ischemic changes. Additional abnormal diagnostic findings on Magnetic resonance imaging (MRI) were demyelinating lesions and encephalitis. The groups were compared for the total number of patients exhibiting any one of these diagnostic abnormalities identified on the CT scan or MRI. EEG was considered pathological if epileptic activity was evident on the scan, and Doppler ultrasonography (US) was considered abnormal if the scan showed carotid stenosis above 70% on the contralateral side of the sensory disturbance(s).\u003c/p\u003e\n\u003ch3\u003eStudy endpoints\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint of the study was the percentage of patients presenting with HS who received a neurological diagnosis. The secondary endpoints were demographic and clinical features typical of the patients who received a neurological diagnosis compared to those who did not, and the specific tests that contributed most to reaching the diagnosis.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize demographic, clinical, and diagnostic characteristics. Continuous variables were summarized as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or, if not normally distributed, as median and interquartile range. Categorical variables were suammarized as number and percentage of patients. Group comparisons were performed between patients with and without a final neurological diagnosis Continuous variables were compared between groups using t-test and Mann-Whitney test, as appropriate, and categorical values were compared using Pearson\u0026rsquo;s chi-square or Fisher exact test. A two-sided \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the total 1116 patients who were examined for sensory symptoms between 2010 and 2020, 922 were excluded from the study mainly because of the presence of mild motor symptoms as well. The remaining 194 formed the study group. Following a comprehensive clinical examination and neurological work-up, 55 (28.3%) received a neurological diagnosis, namely, stroke or transient ischemic attack (24/55, 43.6%), migraine (14/55, 25.4%), multiple sclerosis (13/55, 23.6%), epilepsy (2/55, 3.6%), encephalitis (1/55, 1.8%) and space occupying lesion (1/55, 1.8%).\u003c/p\u003e\n\u003ch3\u003eDemographic and baseline characteristics (Table )\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and baseline characteristics by group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo diagnosis (n\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (yr), median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (33, 51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (33, 54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex (female)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence in periphery\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;193)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;136)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (78%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildren, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmokers\u003c/b\u003e (n\u0026thinsp;=\u0026thinsp;191)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39/139 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14/55 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDominant hand\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight handed (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55/58 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/22 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferent from overall body dominance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39/58 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/22 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eIQR, interquartile range\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComparison of the demographic and baseline characteristics between patients with and without a diagnosis yielded no statistically significant differences age (median 41 years in the diagnosis group and 42 years in the no-diagnosis group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.69), gender ratio, education, or marital status. The majority of patients in both groups were married and had a median of three children. The diagnosis group had a higher proportion of females (69% vs. 59%), but the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.19). Residence in the geographic periphery was rare and similarly distributed between the groups (5% vs. 6%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.72). Most patients had a high school or academic level of education. The dominant hand was right in 92% of patients (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.34). Smoking status was similar in the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.4).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors and medical background (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk factors and comorbidities by group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo diagnosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVascular risk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAutoimmune disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActive malignancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic inflammatory disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of migraines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny medication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46/139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21/55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntiplatelet agents\u003c/b\u003e (aspirin, clopidogrel, or prasugrel)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnticoagulation therapy\u003c/b\u003e (warfarin, apixaban, rivaroxaban, dabigatran)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBeta blockers or calcium channel blockers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStatins\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eACE inhibitors or angiotensin receptor blockers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOral antidiabetic medications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsulin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCorticosteroids\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntidepressants\u003c/b\u003e (SSRIs or SNRIs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCholesterol panel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal cholesterol (mg/dl), median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175 (151,198)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181 (163,204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLDL (mg/dl), median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (75, 122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (84, 126)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHDL (mg/dl), median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (38, 63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (39, 62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTriglycerides (mg/dl), median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (72, 157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (91,188)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eIQR, interquartile range; ACE, angiotensin-converting enzyme; SSRI, selective serotonin reuptake inhibitor; SSNR, serotonin and norepinephrine reuptake inhibitor; LDL, low density lipoprotein; HDL, high density lipoprotein\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn analysis of potential risk factors and comorbidities, there was no difference between the groups in the rate of vascular risk factors (33% vs. 27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.39) or rates of autoimmune diseases and chronic inflammatory conditions, which were low in both. History of migraine was more common in the diagnosis group (9% vs. 3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). Use of any medications, including anticoagulants, statins, anti-hypertensive drugs, diabetes medication, and antidepressants did not differ significantly between the groups. Lipid panel results, including total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were broadly similar, although triglyceride levels were significantly higher in the diagnosis group (median 130 vs. 107 mg/dL, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eNeurological examination and tests (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNeurological examination and tests by group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical complaint/\u003c/p\u003e \u003cp\u003eabnormality found\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. pts. evaluated\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;194)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiagnosis group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo-diagnosis group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;139)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAssociated diagnoses\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePresentation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImpaired sensation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/55 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86/139 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;10), Stroke (n\u0026thinsp;=\u0026thinsp;11), SOL (n\u0026thinsp;=\u0026thinsp;1), Epilepsy (n\u0026thinsp;=\u0026thinsp;1), Migraine (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTendon reflex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11/55 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11/139 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;3), Stroke (n\u0026thinsp;=\u0026thinsp;4), SOL (n\u0026thinsp;=\u0026thinsp;1), Epilepsy (n\u0026thinsp;=\u0026thinsp;1), Migraine (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlantar response\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/55 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/139 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;2), Stroke (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny complaint\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35/55 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94/139 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;11), Stroke (n\u0026thinsp;=\u0026thinsp;13), SOL (n\u0026thinsp;=\u0026thinsp;1), Encephalitis (n\u0026thinsp;=\u0026thinsp;1), Epilepsy (n\u0026thinsp;=\u0026thinsp;2), Migraine (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImaging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCT \u0026ndash; any abnormal finding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21/48 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10/131 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStroke (n\u0026thinsp;=\u0026thinsp;6), Migraine (n\u0026thinsp;=\u0026thinsp;1), Epilepsy (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCT \u0026ndash; abnormal diagnostic findings\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/48 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/131 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStroke (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMRI \u0026ndash; any abnormal finding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/46 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/84 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;13), Stroke (n\u0026thinsp;=\u0026thinsp;12), SOL (n\u0026thinsp;=\u0026thinsp;1), Encephalitis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMRI \u0026ndash; abnormal diagnostic findings\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/46 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/84 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;13), Stroke (n\u0026thinsp;=\u0026thinsp;12), SOL (n\u0026thinsp;=\u0026thinsp;1), Encephalitis (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEEG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/10 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/29 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEpilepsy (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDoppler US\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/53 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/24 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStroke (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSEP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4/8 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/3 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDemyelination (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEchocardiogram\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4/21 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5/41 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStroke (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNormal in all diagnostic tests (194/194, 100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20/55 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120/139 (86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMigraine (n\u0026thinsp;=\u0026thinsp;14), TIA (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e At least one of the following: single new infarct, multiple new infarcts, space-occupying lesion, or vascular lesion\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003eb\u003c/sup\u003e At least one of the following: single new infarct, multiple new infarcts, space-occupying lesion, vascular lesion, demyelination or encephalitis\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCT, computed tomography; EEG, electroencephlogram; MRI, magnetic resonance imaging; SOL, space-occupying lesion; TIA, transient ischemic attack; US, ultrasound; SEP, somatosensory evoked potential\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eObjective neurological abnormalities were detected in 35/55 of patients in the diagnosis group (64%) and 94/139 (68%) in the no-diagnosis group. Compared to the no-diagnosis group, the diagnosis group had a significantly higher rate of abnormalities of deep tendon reflex (11/55, 55% vs 11/139, 8%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023) and plantar response (7/55, 13% vs. 6/139, 4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.052).\u003c/p\u003e \u003cp\u003eNeuroradiological examinations were performed in all patients, including head CT in 179 (92.3%), brain MRI in 130 (67.0%), carotid Doppler ultrasound in 77 (39.7%), echocardiography in 62 (32.0%), EEG in 39 (20.1%), and somatosensory evoked potentials in 11 (5.7%). Given the relatively low number of patients undergoing most tests, diagnostic yield was further analyzed only for CT and MRI.\u003c/p\u003e \u003cp\u003eAmong the 179/194 patients who underwent CT scanning, 31 (17.3%) had any abnormal findings. These included abnormal diagnostic findings in 6/48 patients (13%) in the diagnosis group and none of the 131 patients in the no-diagnosis group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). MRI had the highest diagnostic yield. Of the 130/194 patients who underwent MRI, 33 (25.3%) had any abnormal findings. These included abnormal diagnostic findings in 27/46 patients (58.7%) in the diagnosis group and none of the 84 patients in the no-diagnosis group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). EEG showed epileptogenic findings in 2/10 patients (20%) in the diagnosis group and none of the 29 patients in no-diagnosis group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.061). (see Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study showed that despite a comprehensive clinical investigation, of all patients who presented to the ED of a tertiary medical center with a unilateral sensory complaint, only one-fourth ultimately received a neurological diagnosis. The diagnosis group contained a higher proportion of females than the no-diagnosis group, but the results were clinically nonsignificant. The diagnosis group was characterized by a significantly higher mean triglyceride level and higher rate of history of migraine, with no significant between-group difference in chronic use of medication, side involved, or laboratory values other than triglycerides. Among the neuroimaging tests used, MRI contributed the most to identifying the etiology of the syndrome.\u003c/p\u003e \u003cp\u003eVery few case series have addressed the yield of the diagnostic work-up performed in patients with symptoms of HS. In a previous study of 34 patients, only one was diagnosed on the basis of neuroimaging; findings in the remainder were considered benign [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study identified pure sensory stroke in 4.7% of all acute stroke cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Indeed, it has been reported that subjective sensory hypersensitivity frequently follows acute stroke, especially when the insula, claustrum, and rolandic operculum are involved [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These observations suggest that focusing investigations on these areas might improve our understanding of the underlying mechanism of sensory disturbances. HS may also be associated with complex regional pain syndrome, in which the sensory disturbances intensify with pain chronicity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In these cases, 33% of patients have a sensory impairment beyond the affected limb [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, a neurological diagnosis was achieved in a minority of patients and was more likely in females. The higher proportion of female patients in the diagnosis group was surprising given past research and publications that attributed hemisensory disturbances to non-organic causes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which are mainly attributed to young women with psychiatric disorders [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The higher proportion could be explained by the higher incidence of migraine and demyelinating diseases in females [ref here?].\u003c/p\u003e \u003cp\u003eThe results also showed that in patients in whom a neurological diagnosis was not reached, the non-dominant side was more involved than the dominant side, which supported our initial hypothesis, although the difference was not statistically significant. It is noteworthy that the study sample was small and data for hand dominance were available for less than half the patients (81/194), which may have affected the reliability of the results. The literature on lateralization of symptoms is also inconclusive. In one systematic review of 121 eligible studies comprising 1139 patients, when laterality was mentioned in the title of the study, a higher percentage of the cohort was reported to have greater left side than right side involvement (66%). However, when lateralization was not mentioned in the title, no meaningful difference in side involvement (53% vs 57%) was seen [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePyramidal signs (tendon reflex and plantar response) and signs of corticospinal tract lesions were more abundant in the diagnosis than the no-diagnosis group.\u003c/p\u003e \u003cp\u003eOf all the examinations performed, brain MRI contributed the most to the diagnosis, revealing pathological findings in 59% of patients with a neurological diagnosis, and 21% of all patients who underwent MRI.\u003c/p\u003e \u003cp\u003eData on chronic medication use were sparse, and patients under chronic medication accounted for only a small proportion of the total cohort. Additional studies are needed to address these issues.\u003c/p\u003e \u003cp\u003eSmokers did not demonstrate a higher rate of neurological diagnosis than non-smokers. This finding was surprising given the known harms of smoking. It is possible that because unilateral sensory disturbances affect a relatively young population (median age of our cohort was 42 years), the cumulative damage from smoking had not yet manifested, as in the case of ischemic stroke.\u003c/p\u003e \u003cp\u003eWhile the group with a neurologic diagnosis had a higher mean triglyceride level than the group with no diagnosis, there were no between-group differences in levels of HDL, LDL, and total cholesterol. These findings may reflect the increased vascular morbidity in patients with dyslipidemia, although further study is required to determine why the greatest difference was found specifically for triglycerides.\u003c/p\u003e \u003cp\u003eThis study has several limitations. The retrospective design, as noted, has inherent biases which may have affected the results, and the single-center setting might adversely affect the generalizability of the findings to populations with different characteristics. Moreover, our exclusion of patients who did not complete the recommended clinical evaluation within a year of onset of their complaints could have introduced a selection bias, as we might have missed patients in whom the sensory disturbance had resolved and therefore did not require further treatment. Finally, the small size of the study sample lowered the statistical power of the analysis.\u003c/p\u003e \u003cp\u003eIn conclusion, the present study suggests that the rate of achieving a neurological diagnosis in patients who present with HS is low. In most cases, the etiology of the sensory disturbance will not be found despite extensive investigation. The test that made the greatest contribution to the diagnosis was brain MRI. The results of this study emphasize the need to define additional variables that would aid treating physician in identifying patients in whom a comprehensive medical examination is warranted and which tests to apply, sparing others unnecessary and sometimes costly interventions. Additional studies including broader populations are needed to validate our results and provide additional clinically meaningful data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eI.U- Writing of manuscript text, Data collectionK.S - Data collection.J.F - statistical analysis.R.D - Critical review of manuscript, methodology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from the corresponding author (Ilia Urman), upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003eThis study was conducted in adherence with the Declaration of Helsinki (2024 revision) and approved by the Ethics Committee of Rabin Medical Center (approval no 0322-20-RMC), which waived the need for informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eC\u003cstrong\u003eompeting interest \u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp; All authors have declared that they do not have any conflicts of interest.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKoh PX, Ti J, Saffari SE, Lim ZYIC, Tu T (2021) Hemisensory syndrome: Hyperacute symptom onset and age differentiates ischemic stroke from other aetiologies. BMC Neurol 21:179. https://doi.org/10.1186/s12883-021-02206-8\u003c/li\u003e\n\u003cli\u003eStone J, Carson A, Sharpe M (2005) Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatr 76 Suppl 1(Suppl 1):i2-i12. https://doi.org/10.1136/jnnp.2004.061655\u003c/li\u003e\n\u003cli\u003eda Silva LA, Kazyiama HHS, Teixeira MJ, de Siqueira SRDT (2013) Quantitative sensory testing in fibromyalgia and hemisensory syndrome: comparison with controls. Rheumatol Int 33:2009-2017. https://doi.org/10.1007/s00296-013-2675-6\u003c/li\u003e\n\u003cli\u003eArboix A, Garc\u0026iacute;a-Plata C, Garc\u0026iacute;a-Eroles L, Massons J, Comes E, Oliveres M, Targa C (2005) Clinical study of 99 patients with pure sensory stroke. J Neurol 252:156-162. https://doi.org/10.1007/s00415-005-0622-5\u003c/li\u003e\n\u003cli\u003eEgloff N, Sabbioni MEE, Salath\u0026eacute; C, Wiest R, Juengling FD (2009) Nondermatomal somatosensory deficits in patients with chronic pain disorder: clinical findings and hypometabolic pattern in FDG-PET. Pain 145(1-2):252-258. https://doi.org/10.1016/j.pain.2009.04.016\u003c/li\u003e\n\u003cli\u003eKim JS (1992) Pure sensory stroke. Clinical-radiological correlates of 21 cases. Stroke 23:983-987. https://doi.org/10.1161/01.STR.23.7.983\u003c/li\u003e\n\u003cli\u003eVuilleumier P, Chicherio C, Assal F, Schwartz S, Slosman D, Landis T (2001) Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain 124(Pt 6):1077-1090. https://doi.org/10.1093/brain/124.6.1077\u003c/li\u003e\n\u003cli\u003eToth C (2003) Hemisensory syndrome is associated with a low diagnostic yield and a nearly uniform benign prognosis. J Neurol Neurosurg Psychiatr 74:1113-1116. https://doi.org/10.1136/jnnp.74.8.1113\u003c/li\u003e\n\u003cli\u003eThielen H, Tuts N, Lafosse C, Gillebert CR (2023) The neuroanatomy of poststroke subjective sensory hypersensitivity. Cogn Behav Neurol 36:68-84. https://doi.org/10.1097/WNN.0000000000000341\u003c/li\u003e\n\u003cli\u003eDrummond PD, Finch PM, Birklein F, Stanton-Hicks M, Knudsen LF (2018) Hemisensory disturbances in patients with complex regional pain syndrome. Pain 159:1824-1832. https://doi.org/10.1097/j.pain.0000000000001280\u003c/li\u003e\n\u003cli\u003eRommel O, Malin J-P, Zenz M, J\u0026auml;nig W (2001) Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits. Pain 93:279-293. https://doi.org/10.1016/S0304-3959(01)00332-3\u003c/li\u003e\n\u003cli\u003ePerez DL, Barsky AJ, Daffner K, Silbersweig DA (2012) Motor and somatosensory conversion disorder: a functional unawareness syndrome? J Neuropsychiatry Clin Neurosci 24:141-151. https://doi.org/10.1176/appi.neuropsych.11050110\u003c/li\u003e\n\u003cli\u003eR\u0026eacute;gny P, Cath\u0026eacute;bras P (2016) [Conversion disorder in an internal medicine department: A series of 37 cases]. Encephale 42:150-155. https://doi.org/10.1016/j.encep.2014.11.004\u003c/li\u003e\n\u003cli\u003eStone J, Sharpe M, Carson A, Lewis SC, Thomas B, Goldbeck R, Warlow CP (2002) Are functional motor and sensory symptoms really more frequent on the left? A systematic review. J Neurol Neurosurg Psychiatry 73:578-581. https://doi.org/10.1136/jnnp.73.5.578\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemisensory syndrome, Brain MRI, Diagnostic yield","lastPublishedDoi":"10.21203/rs.3.rs-8552834/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8552834/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHemisensory syndrome (HS) is a subjective unilateral sensory abnormality that causes reduced sensation and chronic pain, with no additional objective findings, posing a diagnostic challenge. We aimed to determine the rate of neurological\u003c/p\u003e\n\u003cp\u003ediagnosis among patients with hemisensory complaints and identify clinical tools to aid in the diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A cross-sectional retrospective study was conducted using data collected from 194 patients who presented to the emergency department of a tertiary medical center with hemisensory complaints in 2010-2020. Their medical records were screened for demographic and clinical features and the results of all ancillary examinations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA neurological diagnosis was reached for 55/194 patients (28.3%), mainly acute stroke/transient ischemic attack in 24 (43.6%), migraine in 14 (25.4%), and multiple sclerosis in 13 (23.6%). The likelihood of diagnosis was not significantly affected by gender, side involvement, or use of chronic medications. Rate of pyramidal signs and mean triglyceride level were increased in the diagnosis group. Brain magnetic resonance imaging (MRI) was the largest clinical contributor to the diagnosis, demonstrating pathological findings in 59% of the diagnosis group (versus zero in the no-diagnosis group) and in 21% of all patients who underwent MRI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe yield of extensive investigations in patients with HS is low, and in only one-fourth of cases is the etiology determined. Brain MRI appears to be the most efficient neuroimaging tool available. Addition variables need to be defined to aid clinicians in identifying patients warranting a comprehensive medical examination and in determining which tests to apply.\u003c/p\u003e","manuscriptTitle":"Rate of neurological diagnosis in patients with hemisensory syndrome – A retrospective cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 09:14:37","doi":"10.21203/rs.3.rs-8552834/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f50fcda0-9c27-446f-a19a-5b4d78b6f74f","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:19:47+00:00","versionOfRecord":{"articleIdentity":"rs-8552834","link":"https://doi.org/10.1007/s13760-026-03044-6","journal":{"identity":"acta-neurologica-belgica","isVorOnly":false,"title":"Acta Neurologica Belgica"},"publishedOn":"2026-03-25 16:12:37","publishedOnDateReadable":"March 25th, 2026"},"versionCreatedAt":"2026-01-16 09:14:37","video":"","vorDoi":"10.1007/s13760-026-03044-6","vorDoiUrl":"https://doi.org/10.1007/s13760-026-03044-6","workflowStages":[]},"version":"v1","identity":"rs-8552834","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8552834","identity":"rs-8552834","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}